迷走神经微血管减压术在原发性高血压病治疗中的疗效观察

摘要

目的 观察迷走神经微血管减压术(MVD)对原发性高血压病的疗效.方法 左侧三叉神经痛、舌咽神经痛合并原发性高血压的病人13例,在行左侧三叉神经或迷走神经微血管减压术的同时行迷走神经、左侧延髓微血管减压术,观察病人术前、术后服用抗高血压药物种类、剂量的变化.结果 术中发现小脑后下动脉及分支从前下方向上挤压迷走神经6例,从前上方向下接近或压迫迷走神经5例,椎动脉主干从前方挤压或牵拉迷走神经腹侧2例.5例病人的高血压病得到治愈,8例病人的高血压病得到好转.结论 左侧迷走神经、延髓MVD可以有效治疗原发性高血压病.术中解除血管节律性搏动对迷走神经及延髓腹外侧的刺激可以提高左侧迷走神经、延髓MVD在原发性高血压病手术治疗中的疗效.%Objective To investigate the effect on treating elevated blood pressure of the vagal microvascular decompression (MVD) in patients with trigeminal or glossopharyngeal neuralgia complicated with hypertension. Methods 13 patients with left trigeminal or glossopharyngeal neuralgia complicated with hypertension underwent left trigeminal or lossopharyngeal MVD, and all the cases were simultaneously treated with MVD of left vagus and the left rostral ventro-lateral medulla oblongata. The changes of postoperative blood pressure, antihypertension medication types and dosage were observed. Results Posterior inferior cerebellar artery and branches squeezed the vagus upward from the anterior-inferior were found in 6 cases, close to or oppressing the vagus downward from anterior - superior in 5 cases, the trunk of vertebral artery squeezed or stretched the ventral part of vagus from anterior were found in 2 cases. Relief in the hypertension was observed in 5 of the patients and improvement in eight. Conclusion Microvascular decompression of the left vagus and left rostral ventrolateral medulla oblongata may be an effective treatment of hypertension via relieving the stimulation of left vagus and left rostral ventrolateral medulla oblongata causing caused by vascular rhythm beats.